2018-03-19T11:27:49ZSatisfaction with healthcare services in South Africa: results of the national 2010 General Household Surveyhttp://hdl.handle.net/1920/9916
Satisfaction with healthcare services in South Africa: results of the national 2010 General Household Survey
Jacobsen, Kathryn H.; Hasumi, Takahiro
Introduction
The 1998 and 2003 Demographic and Health Surveys suggested increasing rates of dissatisfaction with health services in South Africa. The goal of this analysis was to examine national healthcare satisfaction rates in 2010.
Methods
We conducted weighted logistic regression analysis of data from 22,959 household representatives who participated in the nationally-representative 2010 General Household Survey (GHS).
Results
In total, 88.5% of participants were somewhat or very satisfied with their last visit to their usual healthcare provider, including 84.6% of those visiting a public provider and 97.3% of those consulting a private provider. Satisfaction rates were lower for black South Africans (87.0%) and low income households (86.3% of households with monthly incomes less than 2500 rands) than for white South Africans (96.0%) and high income households (94.0% of those with monthly incomes of at least 8000 rands) (p<0.001). However, after adjusting for provider type, there were few differences in satisfaction rates by race/ethnicity and income level.
Conclusion
The analysis suggests that differences in satisfaction with healthcare services in South Africa by racial/ethnic group and income level are due in large part to different rates of use of private providers.
2014-06-22T00:00:00ZDiabetes, obesity, and recommended fruit and vegetable consumption in relation to food environment sub-types: a cross-sectional analysis of Behavioral Risk Factor Surveillance System, United States Census, and food establishment datahttp://hdl.handle.net/1920/9896
Diabetes, obesity, and recommended fruit and vegetable consumption in relation to food environment sub-types: a cross-sectional analysis of Behavioral Risk Factor Surveillance System, United States Census, and food establishment data
Frankenfeld, Cara L.; Leslie, Timothy F.; Makara, Matthew A.
Background
Social and spatial factors are an important part of individual and community health. The objectives were to identify food establishment sub-types and evaluate prevalence of diabetes, obesity, and recommended fruit and vegetable consumption in relation to these sub-types in the Washington DC metropolitan area.
Methods
A cross-sectional study design was used. A measure of retail food environment was calculated as the ratio of number of sources of unhealthier food options (fast food, convenience stores, and pharmacies) to healthier food options (grocery stores and specialty food stores). Two categories were created: ≤1.0 (healthier options) and >1.0 (unhealthier options). k-means clustering was used to identify clusters based on proportions of grocery stores, restaurants, specialty food, fast food, convenience stores, and pharmacies. Prevalence data for county-level diabetes, obesity, and consumption of five or more fruits or vegetables per day (FV5) was obtained from the Behavioral Risk Factor Surveillance System. Multiple imputation was used to predict block-group level health outcomes with US Census demographic and economic variables as the inputs.
Results
The healthier options category clustered into three sub-types: 1) specialty food, 2) grocery stores, and 3) restaurants. The unhealthier options category clustered into two sub-types: 1) convenience stores, and 2) restaurants and fast food. Within the healthier options category, diabetes prevalence in the sub-types with high restaurants (5.9 %, p = 0.002) and high specialty food (6.1 %, p = 0.002) was lower than the grocery stores sub-type (7.1 %). The high restaurants sub-type compared to the high grocery stores sub-type had significantly lower obesity prevalence (28.6 % vs. 31.2 %, p <0.001) and higher FV5 prevalence (25.2 % vs. 23.1 %, p <0.001). Within the larger unhealthier options category, there were no significant differences in diabetes, obesity, or higher FV5 prevalence across the two sub-types. However, restaurants (including fast food) sub-type was significantly associated with lower diabetes and obesity, and higher FV prevalence compared to grocery store sub-type.
Conclusions
These results suggest that there are sub-types within larger categories of food environments that are differentially associated with adverse health outcomes. These observations support the specific food establishment composition of an area may be an important component of the food establishment-health relationship.
2015-05-14T00:00:00ZThe impact of demographic and perceptual variables on a young adult’s decision to be covered by private health insurancehttp://hdl.handle.net/1920/9885
The impact of demographic and perceptual variables on a young adult’s decision to be covered by private health insurance
Cantiello, John; Fottler, Myron D.; Oetjen, Dawn; Zhang, Ning Jackie
Background.
The large number of uninsured individuals in the United States creates negative consequences for those who are uninsured and for those who are covered by health insurance plans. Young adults between the ages of 18 and 24 are the largest uninsured population subgroup. This subgroup warrants analysis. The major aim of this study is to determine why young adults between the ages of 18 and 24 are the largest uninsured population subgroup.
Methods.
The present study seeks to determine why young adults between the ages of 18 and 24 are the largest population subgroup that is not covered by private health insurance. Data on perceived health status, perceived need, perceived value, socioeconomic status, gender, and race was obtained from a national sample of 1,340 young adults from the 2005 Medical Expenditure Panel Survey and examined for possible explanatory variables, as well as data on the same variables from a national sample of 1,463 from the 2008 Medical Expenditure Panel Survey.
Results.
Results of the structural equation model analysis indicate that insurance coverage in the 2005 sample was largely a function of higher socioeconomic status and being a non-minority. Perceived health status, perceived need, perceived value, and gender were not significant predictors of private health insurance coverage in the 2005 sample. However, in the 2008 sample, these indicators changed. Socioeconomic status, minority status, perceived health, perceived need, and perceived value were significant predictors of private health insurance coverage.
Conclusions.
The results of this study show that coverage by a private health insurance plan in the 2005 sample was largely a matter of having a higher socioeconomic status and having a non-minority status.
In 2008 each of the attitudinal variables (perceived health, perceived value, and perceived need) predicted whether subjects carried private insurance. Our findings suggest that among those sampled, the young adult subgroup between the ages of 18 and 24 does not necessarily represent a unique segment of the population, with behaviors differing from the rest of the sample.
2015-05-12T00:00:00ZAn Evaluation Synthesis of US AIDS Drug Assistance Program Policyhttp://hdl.handle.net/1920/8992
An Evaluation Synthesis of US AIDS Drug Assistance Program Policy
Horneffer, Michael A.; Yang, Y. Tony
US Congress passed the CARE Act in 1990 in response to a dramatically growing need for resources to combat the AIDS epidemic. One of the programs contained in the Act was the AIDS Drug Assistance Program (ADAP), a federally-funded but state-maintained and managed program primarily concerned with providing medication for low-income HIV/AIDS patients. While ADAP programs across the country reached one-third of all patients in 2007, these programs are now in budgetary danger due to the economic recession, state budgetary constraints, the rising cost of healthcare generally, and longer life expectancies associated with current highly active antiretroviral therapy (HAART). This paper first evaluates the current state of ADAP, its strengths and weaknesses, and examines its sustainability in the short term if short-term measures are taken. Concluding that such measures would not lead to long-term sustainability, this paper then argues for a long-term solution to ADAP’s current problems, namely a national, centralized ADAP standard for budgetary and administrative matters. Such a program would increase the long-term sustainability and effectiveness of current ADAP programs by employing more efficient, standard policies and allowing larger, wholesale purchases of costly HAART medications. Moreover, a national policy would address the disparity that currently exists in ADAP programs today with regard to both minorities and those on the waiting lists for treatment. The institution of a national ADAP program would certainly face many political hurdles. Consequently, this paper also looks to a recent political dispute, the enactment of the Affordable Care Act (ACA), for guidance. Using the passage of the ACA as an example could light the path for passage of a national ADAP standard. Ultimately, this would lead to a more effective and sustainable program for HIV/AIDS patients in the United States.
2013-06-01T00:00:00Z